European Journal of Cardiovascular Medicine

Chronic non-healing ulcers represent a significant burden on patients and healthcare systems worldwide, particularly when complicating factors such as hypertension and dyslipidaemia are present. These conditions not only impair wound healing but also increase the risk of complications such as infection and amputation. While conventional wound care measures play a crucial role in ulcer management, some cases may necessitate advanced interventions like skin grafting to achieve satisfactory outcomes. Here, we present a case of a neglected non-healing ulcer over the dorsum of the right foot in a patient with hypertension and dyslipidaemia, successfully treated with skin grafting.

Case Presentation: A 38 -year-old male presented to our composite hospital with a non-healing ulcer over the dorsum of his right foot. The patient reported with a history of hypertension and dyslipidaemia, controlled with antihypertensive and lipid-lowering medications, respectively. He reported history of minor trauma to the affected foot with gradual worsening of the ulcer over the past six months. Despite regular wound care consisting of debridement, dressings, and offloading, the ulcer failed to show signs of healing and was associated with persistent pain and discharge.

On examination, a non-healing ulcer measuring 16.5 cm x 7.5 cm was noted over the dorsum of the right foot, with surrounding erythema and maceration. Peripheral pulses were palpable, and sensory examination revealed intact sensation. Ankle-brachial index (ABI) was within normal limits. Doppler study of both legs. Laboratory investigations including complete blood count, renal and liver function tests, and HbA1C were unremarkable.

Management: Given the lack of progress with conventional wound care measures, the patient was counselled regarding the option of skin grafting. After obtaining informed consent, he underwent surgical debridement of the ulcer and application of a split-thickness skin graft harvested from the right thigh under spinal anaesthesia. The graft was secured in place with sutures, and a non-adherent dressing was applied. Postoperatively, the patient was advised to keep the foot elevated and avoid weight-bearing for three weeks.

Outcome: The postoperative period was uneventful, with the graft showing good adherence and vascularization. The patient reported significant improvement in pain and discharge. Weekly wound assessments were conducted, revealing progressive epithelialization of the graft site. By the Six-week post-surgery, complete wound closure was achieved, with no signs of infection or graft rejection. The patient was able to resume normal activities without limitations. He was reviewed after every 02 months for six months.

Chronic non-healing ulcers present complex challenges in clinical management, particularly in patients with comorbidities such as hypertension and dyslipidaemia. While conventional wound care measures remain the cornerstone of treatment, some cases may require advanced interventions like skin grafting to promote healing and prevent complications. Skin grafting offers several advantages in ulcer management, including rapid closure, improved cosmesis, and reduced risk of infection.

In our case, skin grafting proved to be an effective intervention in achieving complete wound closure and restoring foot function in a patient with a neglected non-healing ulcer. The successful outcome highlights the importance of considering advanced interventions early in the course of treatment, especially in patients with comorbidities that may impair wound healing. Further studies are warranted to evaluate the long-term efficacy and cost-effectiveness of skin grafting in this patient population.

We report a case of a neglected non-healing ulcer over the dorsum of the right foot in a patient with hypertension and dyslipidaemia, successfully treated with skin grafting. This case underscores the importance of considering advanced interventions like skin grafting in the management of chronic ulcers, especially in patients with comorbidities that may impair wound healing. Further research is needed to optimize the selection and timing of interventions in this patient population.

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